Youth health and well-being:

Why it matters
Diane Cooper (School of Public Health, University of the Western Cape),
Ariane De Lannoy (Poverty and Inequality Initiative and Southern Africa Labour and Development Research Unit, University of Cape Town) and
Candice Rule (Human and Social Development Research Programme, Human Sciences Research Council)

ver half of the South African population are under the

What do we know about youth health?

age of 25. This youth bulge has the potential to provide

a future demographic dividend to South Africa in the

Together, adolescence and young adulthood represent

form of increased economic productivity. However, such a boon

a period of experimentation and identity formation, and

is dependent on a number of factors, key of which is that young

also a time when lifelong behaviour patterns are typically

people are healthy. Currently, the burden of disease among youth is

initiated or established. WHO estimates that 70 percent

high, with tuberculosis (TB) and HIV emerging as the leading causes

of premature deaths in adults worldwide are the result of

of death among all youth in the country, along with violence and

behaviors begun in adolescence.4

traffic accidents for young men.1

Adolescence and young adulthood are times of rapid physical and

Improving the health and well-being of adolescents and youth

psychosocial change and development. They are stages in which

is crucial for their well-being today, and for their future economic

parental influence decreases and the influence of peers and media

productivity, because behaviour and health developed during these

increases.5 As a result, these stages are often associated with a

stages of life are key predictors of the adult burden of disease,

rise in experimentation and exploration, a search for identity, and

and because health like education is a key factor in the

a consequent increase in risky behaviour, alcohol and substance

intergenerational transmission of poverty.2

use and abuse, possible sexual and reproductive health (SRH)

Better youth health is dependent on the provision of high-

problems, violence and mental illness.6 In addition, growing up in

quality health services, but is also much intertwined with factors

poverty creates specific challenges for a large proportion of the

falling outside the realm of the health sector.3 Poverty, in all its

countrys youth.

dimensions,i undermines health and well-being through a variety

In South Africa, the leading causes of death among young

of pathways. Poor nutrition, for example, impacts negatively on

people differ by gender, race and income status. Statistics South

a young persons capacity to learn, progress through school and

Africa reports that the leading causes of death among young men

earning potential. Poor living conditions and physical inactivity lead

aged 15 29 in 2013 were external causes, with a peak among

to a higher burden of chronic respiratory and/or heart disease.

20 24-year-olds. This reflects the risk of violence, injuries and

Exposure to domestic violence and harsh discipline increases the

traffic accidents. Among young women of the same age group,

risk of young people becoming either victims or perpetrators of

communicable diseasesii were the leading cause of death, in

violence.

particular TB and HIV.7

Individual factors such as delinquency and substance abuse

This section outlines some of the leading health issues affecting

impact on young peoples well-being and are predictors of future ill

South Africas youth, including sexual and reproductive health

health. Family level factors such as the absence of warm, positive

(SRH) and violence. It further elaborates on substance abuse and

parenting, as well as community level elements such as gang

mental health, both of which are intricately related to the drivers

violence, for instance, impact on the emotional health of youth and

and consequences of ill health. The essay further highlights how

may, in turn, undermine educational outcomes and employment

young peoples lifestyle choices are shaped by a complex interplay

chances.

of social norms, economic, gender and spatial inequalities, poor

Against this backdrop, this essay provides an overview of the

current state of youth health and well-being in South Africa and

physical environmental conditions and inadequate access to

services.

identifies opportunities to improve outcomes by focusing on the

following key questions:

Sexual and reproductive health

What do we know about youth health?

Exploring sexuality and intimate relationships are key components

What is being done to improve youth health?

of youth SRH and well-being. However various social factors such

What can strengthen initiatives to improve youth health?

as peer pressure, intimate partner violence, rape, a lack of knowledge

i The essay on p. 22 and the Children Count The Numbers section on p. 100 outline multiple dimensions of deprivation for children and young people in South Africa.
ii Communicable diseases are those diseases that are infectious and include, among others, diseases such as tuberculosis, intestinal infectious diseases and
influenza and pneumonia. (See no. 1 in references)

60

South African Child Gauge 2015

about SRH and barriers to contraception also contribute to high

HIV

rates of unprotected sex.8 This places a substantial proportion of

Globally, young people aged 15 24 comprise 41% of new HIV

South Africas youth at risk of unwanted pregnancies, sexually-

infections in those older than 15 years.16 In South Africa, young

transmitted infections (STIs), and HIV infection. Young women bear

women aged 15 19 are at highest risk of HIV and eight times

a disproportionately high burden of sexual and reproductive ill

more likely to be HIV positive than similar aged young men (5.6%

health.

vs 0.7%).17 Furthermore, HIV is related to a range of other illnesses

such as TB, listed by Statistics South Africa as the leading cause of

Youth pregnancy

death among young women.18

Youth pregnancy is associated with significant health risks and

The drivers of the HIV and AIDS pandemic are complex and

socio-economic costs. While South Africas teenage childbearing

multi-faceted. Women have a higher biological susceptibility to HIV,

declined from 30% to 23% from 1984 to 2008,9 it remains a serious

but a host of sociocultural and economic factors rooted in gender

concern. Teen mothers have poorer educational outcomes than

power inequities [further] exacerbate womens vulnerability

non-teen mothers, which has negative implications for their future

to infection.19 Gender inequality, coerced sexual relations and

chances economically.10 Studies consistently find that pregnancy

economic insecurity that leads to transactional sex make it

and childbearing contribute significantly to falling behind and

significantly more difficult for young women to negotiate condom

dropping out of school,11 as well as discrimination and exclusion

use: Between 2008 and 2012, reported condom use by males at

from school12.

last sex declined from 85% to 68% while reported condom use by

Pregnant teenagers are at greater risk of maternal health

problems, accounting for 33% of all maternal deaths in South Africa.

13

females declined from 67% to 50%.20

Research consistently indicates the negative economic and

Early access to antenatal care is critical for safer pregnancies and

psychosocial impact of HIV infection on families and individuals,

birth, yet youth attendance is particularly poor. Pregnant girls and

especially adolescents and youth.21 The expansion of antiretroviral

young women cite the lack of privacy, confidentiality, and the fear

treatment also means that babies infected in the perinatal period

of coerced HIV testing, as some of the obstacles to attending

are living healthy lives, thus entering adolescence and young

health care services.14 Furthermore, children born to teen mothers

adulthood. While they have SRH needs common to other youth, they

are at risk of poorer health and educational outcomes feeding the

also have needs specific to living with HIV. Many recount insecurity

intergenerational cycle of poverty.

in approaching intimate relationships due to their HIV status and

Kuthalas story (case 6) illustrates the interplay of various factors

rarely have their SRH needs adequately met in HIV care.22

that shape young adolescents decisions around sexual behaviour

the inaccessibility of youth-friendly health services and a lack

Violence

of support and information after birth which have a cumulative

Most young people in South Africa are exposed to violence in

impact on young girls education and emotional health.

their homes, schools and broader neighbourhoods this includes

Case 6: Khutala The health complexities of a young mothers life in a South African township
Khuthala (not her real name) was 18 at the time of our first

This echoes other research which describes how medical staff

interview, and mother of a one-year-old boy. She lived in

can be unsupportive of teens, scolding them for sexual activity

Gugulethu with her mother, father, brother and baby. As a child,

and being reluctant to provide them with contraceptives.15

her father drank, abused her mother, and left no money for

Khuthala was left alone to make a decision about contraception

school fees, uniforms or food. Her grandparents therefore asked

within a relationship she considered stable and mature enough

her to come and live with them in the Eastern Cape but when

not to use condoms any more. She had unprotected sex with

they died, she moved back to Cape Town. Khuthala still resented

her boyfriend of over a year and fell pregnant.

her father, but reported that she had a stable relationship with
her mother, who supported her during her pregnancy.
Khuthala loved school but her unplanned pregnancy led
to her dropping out in grade 11. Her story reflects how the

After the birth of the baby, Khuthala felt she had lost
herself, as she could no longer go to school and had no time to
read or think. She felt stupid about having fallen pregnant, but
tried to maintain a positive attitude.

institutions that are expected to provide guidance and support

She considered finding a part-time job, taking the baby to

fail todays youth: Her family home was not a place of safety and

crche and studying part-time once the child was two years

when Khuthala went to the clinic to ask for the contraceptive

old. However, a year later she had taken on a full-time job in a

pill, the nurses told her they only gave injections.

clothing shop because something had happened at home. She

was uncertain about her chances of returning to school.

Source: De Lannoy A (2008) Educational Decision-making in an Era of AIDS. PhD Thesis. Cape Town: University of Cape Town.

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Youth and the intergenerational transmission of poverty

61

homicides, intimate partner violence and rape. Exposure to

can lead to negative social behaviour.36 In South Africa, alcohol,

violence and deviant peer behaviour increases the likelihood of

tik (crystal methamphetamine) and mixed drug use are linked

high risk and violent behaviour among youth as they seek stronger

to increased physical and sexual violence and crime.37 Substance

connections with peers. Further, structural factors such as poor

misuse is also associated with riskier sexual behaviour, which

quality education, high levels of unemployment and economic

increases risks of HIV and STIs. Intervening early is therefore key to

hardship may lead youth to be attracted to gang-related activities.23

enhancing young peoples well-being today, and to ensuring better

Experiences of violence in South Africa are shaped by age,

health in the future.

gender, socio-economic status and geographical location. A

South Africas youth increasingly engage in hazardous drinking

disproportionate number of young men in the country are both

and drug abuse, and the treatment demand for youth substance

victims and perpetrators of violence,24 and data on registered

abuse and addiction has increased over the past two decades.

deaths in 2013 show that external causes of death accounted

Alcohol and cannabis are the main substances of choice, but youth

for approximately 60% of deaths among young men aged 15

are also experimenting with, and abusing methamphetamines,

24 . Young men living in poor, urban areas are at greatest risk

heroin and mandrax.38 Overall smoking among South Africas high

of interpersonal violence, whereas girls and young women are

school students decreased from 23% to 17% between 1999 and

at highest risk of sexual violence.26 Dominant constructions of

2011, but increased slightly for girls.39 Box 5 highlights problems

masculinity, including norms that demand toughness and strength

with alcohol and drug misuse amongst South Africas youth.

25

and avoiding expressions of emotion and weakness,

27

increase

the chances of men becoming both victims and perpetrators

Box 5: Youth alcohol and drug misuse

of violence and place young women at risk of sexual violence.

49.2% of South Africas school-going youth have had one or

Violence is particularly prevalent in poor communities where

poverty, unemployment, poor quality schooling and a lack of
recreational facilities may leave little opportunity for young men
to gain a sense of belonging and respect. Feelings of frustration
and marginalisation may find expression in violent encounters with
women and other young men.28

more alcoholic drinks in their lifetime.

Approximately a third (32.3%) of these youth reported
having engaged in binge-drinking on one or more days in
the month preceding the survey.
12.7% of the youth reported having used cannabis in their
lifetime.

Sexual and intimate partner violence against girls and women

are leading causes of health problems such as unwanted pregnancy
and STIs, HIV infection, and mental health problems such as posttraumatic stress disorder.29 In 2013/2014, 46,253 rapes were
reported to the police,30 and this is estimated as a fraction of actual

11.5% of learners reported having used at least one

of the following drugs: mandrax, heroin, cocaine or
methamphetamine.
Source: Reddy SP, James S, Sewpaul R, Sifunda S, Ellahebokus A, Kambaran NS &
Omardien RG (2013) Umthente Uhlaba Usamila The 3rd South African National Youth Risk
Behaviour Survey 2011. Cape Town: South African Medical Research Council.

rapes in South Africa.31 Girls younger than 20 report high rates of

coerced sex, particularly in first sexual encounters.32

Key drivers of drinking include peer pressure, boredom, high youth

I was still young, I was about 15. This guy would force me
to do what he wants me to do at his own time. He would
hit me, try to have sex with me, close the door, tie me [up]
to have sex with him. (22-year-old female, Johannesburg)

33

The

Youth Risk Behaviour Survey (YRBS) provides data on

experiences of violence among public high school learners in

grades 8 11.34 In the month before the survey, a third of learners
reported being bullied at school, 17% reported feeling unsafe
travelling to school, and 13% reported carrying a weapon. Sexual
and intimate partner violence are also prevalent: 11% of learners
reported being assaulted by their romantic partner in the six
months preceding the survey; and just under 10% of learners had
experienced forced sex.
Substance abuse
Globally, an estimated 70% of premature adult deaths are the
result of behaviours begun in adolescence, many of which relate
to substance use.35 Tobacco use, for example, is a leading cause
of adult non-communicable diseases such as chronic respiratory
diseases, heart diseases and cancer. Excessive alcohol use can
create long-term liver and kidney problems, brain changes and

62

South African Child Gauge 2015

unemployment and cheap and easy access to alcohol.40 Research

in Durban and Cape Town with 1,468 girls and boys aged between
12 17 has highlighted the significant impact of environmental
stressors (such as discrimination and violent victimisation), parental
child-rearing (the absence of warm, positive parenting), parental
drug use, peer drug use, and adolescent personal attributes
(especially delinquency) on youth illicit substance abuse.41 A
more recent study with ov er 2,000 youth in South Africa found a
strong connection between environmental factors such as violent
victimisation and low well-being, i.e. depression, low self-esteem
or ill health. These, in turn, influenced alcohol use and smoking in
adolescents.42 This underlines the need to understand emotional
well-being of South Africas adolescents in more detail.
Mental health
There is growing evidence that poverty increases the risk of mental
illness, and that people with mental illnesses are more likely to
drift into or remain in poverty. While the precise mechanisms are
unclear, two primary causal pathways have been identified (see
figure 15). Poverty is often associated with experiences of social
exclusion, heightened stress, violence and trauma, which may

increase the risk and severity of mental illness and substance

misuse, and compromise access to care. At the same time people
with mental illness are more likely to slide into poverty as a result
of increased health expenditure, stigma, loss of employment and
income.43
In addition, exposure to violence, substance abuse and HIV lead
to increased vulnerability to mental health problems among young
people.44 The YRBS found that one in four youth (24.7%) reported
feeling sad or hopeless, and just under 18% had made at least
one suicide attempt. Only 37.2% of youth who reported feelings
of sadness had sought treatment from a counsellor or doctor.
Significantly, more young women (20%) than young men (15%) had
considered suicide. The report recommended that:

What is being done to improve youth health?

Since 1994, government has introduced a range of laws, policies
and programmes to promote youth health. However, their impact
has been variable due to challenges with policy design and
implementation, and due to insufficient attention to the underlying
social determinants of youth health.
Non-governmental youth health programmes focus primarily on
the prevention of violence and promotion of sexual and reproductive
health. These include national media campaigns promoting HIV
awareness among youth such as Soul City and loveLife, and peer
education programmes to prevent HIV and gender-based violence
such as Stepping Stones.
Evaluation of these type of programmes shows varying measures

More research needs to be conducted to explore the

of success.49 Shortcomings identified in several programmes

underlying determinants of this serious mental health

highlight the limitations of attempting to change individual

problem. Intervention development and implementation

health behaviours without adequately addressing broader social

needs

determinants of health.

to

be

accelerated

together

with

evaluation

mechanisms for both treatment and prevention of these

mental health problems.45
Finally, poor mental health is related to other health and
developmental concerns in young people such as lower educational
achievement, substance abuse, violence and poorer reproductive
and sexual health.46 Mental health disorders are also accompanied
by suffering, stigma and financial strain,47 which can influence the
extent to which mental health disorders are reported and lead to

Adolescent and youth-friendly clinics

Despite a legal entitlement to sexual and reproductive health care,
including contraception on request from age 12, and abortion in
terms of the law without an age restriction, youth experience
numerous barriers in accessing health care. These include transport
costs, clinic hours clashing with school timetables, a lack of privacy
and confidentiality, and negative attitudes of health care workers.50

underestimated prevalence data48.

Figure 15: A vicious cycle of poverty and mental ill health

Social causation
Social exclusion
High stress
Reduced access to social capital
Malnutrition
Obstetric risks
Poverty
Economic deprivation
Low education
Unemployment
Lack of basic amenities/housing
Food/water insecurity

Mental ill health

Higher prevalence
Poor/lack of care
More severe course

Social selection or social drift

Increased health expenditure
Loss of employment
Reduced productivity

Source: Lund C, de Silva M, Plagerson S, Cooper S, Chisholm D, Das J, Knapp M & Patel V (2012) Poverty and Mental disorders: Breaking the Cycle in Low-income and Middle-income Countries.
Prime Policy Brief 1. Cape Town: Programme for Improving Mental Health Care, UCT.

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Youth and the intergenerational transmission of poverty

63

Case 7: Assessing school, facility and community-based

sexual and reproductive health services

The policy also provides for health education in schools to

address hygiene, nutrition, abuse, sexual and reproductive health,
menstruation, contraception, STIs and HIV, male circumcision,

After extensive community consultation, the Centre for AIDS

pregnancy and termination of pregnancy, drug and substance

Programme of Research in South Africa piloted a youth SRH

abuse and suicide.55 While these new initiatives are important,56

intervention programme in the Vulindlela area of KwaZulu-

school health services are unlikely to be able to meet all youth

Natal in 2011/12 to assess adolescents preferences

health needs. Expansion of initiatives offering sport, recreation and

for different forms of SRH interventions. Students in 14

community-based services for in- and out-of-school youth are also

schools were rotated through three SRH interventions. In

of key importance.57

one intervention arm, students were provided with schoolbased services including group information and awareness
sessions led by school nurses and a mobile clinic service.
In a second arm, individual SRH counselling was
provided at school in collaboration with an NGO focusing on
relationships, negotiating sex, assertive behaviour and highrisk sexual practices. In a third arm, students could either
access school-based SRH counselling and services, or SRH
services at primary health clinics. Services were offered both
during and out of school hours.
The evaluation of the pilot showed that brief in-class
information sessions facilitated student uptake of individual
SRH and HIV counselling and testing.

In general, youth

preferred in-school and mobile services that offered a variety

of SRH information, counselling and care rather than those
based at health care facilities.
Source: Frohlich JA, Mkhize N, Dellar RC, Mahlase GB, Montague CT & Abdool Karim
Q (2014) Meeting the sexual and reproductive health needs of high-school students
in South Africa: Experiences from rural KwaZulu-Natal. South African Medical Journal,
104(10): 687-690.

Efforts to address violence

Physical and sexual violence is criminalised in South Africa, falling
within the ambit of either the Childrens Act, Domestic Violence
Act or the Sexual Offences Act. Family violence, child abuse and
sexual offences police units and special sexual offences courts
were established in 1999, disbanded in 2011, and reintroduced
following pressure from civil society in 2013. Government has also
established Thuthuzela Care Centres in communities where rates
of rape are particularly high. These centres bring together specially
trained health professionals, social workers, police investigators
and prosecutors to reduce secondary trauma, improve conviction
rates and enhance coordination across different services.
Non-governmental organisations such as Mosaic and Rape
Crisis provide valuable models of counselling and care for survivors
of sexual violence. The Tswaranang Legal Advocacy Centre to End
Violence Against Women gives legal assistance and advice on
access to health services for women survivors of sexual violence.
The Shukumisa Campaign promotes action by government and
civil society organisations against sexual violence, while the Sexual

In 1999 the government introduced the National Adolescent

Friendly Clinic Initiative (NAFCI) to improve delivery of facilitybased SRH services to youth. A recent analysis of NAFCIs impact
indicates that:
[A] youth-targeted reproductive health initiative has the

Council is building a research evidence base and feeding into

government policy. In addition, Sonke Gender Justice works with
men and boys, and its peer education programmes engage them
in activities to challenge attitudes, values and behaviours that
compromise their own health and safety and that of women.58

potential to substantially and significantly reduce the

While a number of local campaigns against sexual violence

likelihood of early teen childbearing [The] preliminary

have been implemented successfully across rural and urban South

results suggest an increase in educational attainment

African communities, there is a need for more rigorous evaluation

related to delaying age at first birth. 51

to establish the strengths and limitations of these campaigns.59

Further analysis is needed, however, to disentangle exactly how

the different components of NAFCI education and increased
access to clinical care impact on teen fertility.
School-based programmes and services
School-based health services are widely considered an effective
strategy for providing comprehensive primary health care to schoolgoing youth.52 South Africa is introducing school health teams as
part of its primary health care re-engineering programme.53 Its
new Integrated School Health Policy aims to strengthen existing
services and will offer: screening for sight, hearing and oral
hygiene; treatment of minor conditions; SRH counselling and either
provision of, or referral for, contraceptive services.54 (While making
condoms available in schools is under review, current policies do
not allow for provision of condoms or contraception at school.)

64

Violence Research Initiative at the South African Medical Research

South African Child Gauge 2015

Substance abuse initiatives

Since

the

mid-1990s

the

government

has

implemented

comprehensive tobacco control measures banning advertising

of tobacco products, classifying nicotine as an addictive drug,
restricting smoking in public places, increasing excise duties, and
prohibiting the sale of cigarettes to children under 18. School-based
education programmes discourage smoking. School-going youths
decreased smoking prevalence is important, particularly given
increased smoking rates among adolescents globally. However,
girls increased smoking rates need attention.
Similarly, the government has introduced a number of
mechanisms to reduce alcohol availability to minors through
increased taxation and restricting liquor outlets,60 but alcohol
remains easily accessible to youth.

Case 8: Disability and the perpetuation of poverty A need for inclusive youth development
Theresa Lorenzo and Roshan Galvaan
The UN Convention of the Rights of Persons with Disabilities

Disabled youth identified poor health and skills development

defines disability as including those who have long-term

as the main barriers to securing employment opportunities.68

physical, mental, intellectual or sensory impairments which

Further analysis of a snowball sample of 523 disabled youth

in interaction with various barriers may hinder their full and

aged 18 35 years identified how the presence of community

effective participation in society on an equal basis with others.

rehabilitation

Recognising that disabled youth represent 7.5% of the total

improvements in disabled youths access to health care

population of youth in South Africa,62 the National Youth Policy

and education, which should improve their participation in

calls for inclusive policies that promote equal opportunities

economic development.69 Better dissemination of information

61

workers

was

associated

with

significant

for disabled youth. Groce supports this call, pointing out that

at community level could enable youth with disabilities to

the needs of both disabled and non-disabled youth are similar.

engage in social activities. Recreational facilities also need to

Yet many programmes miss the opportunity to address the

be made accessible.70

63

specific needs of youth with disability. Basic infrastructure

Untreated mental disorders in youth have a negative impact

developments should address the inaccessibility of toilets,

on adjustment to and productive participation in adulthood.71

housing and transport as physical assets.

While disability

For example, stigma and limited access to services may affect

grants significantly improve general living conditions, financial

their ability to deal with mental illnesses and to participate fully

resources and material possessions, persons with disabilities

in opportunities and may serve to further perpetuate poverty.

are excluded from equal access to employment and education.

Health promotion, violence and substance abuse prevention

64

65

A cross-sectional survey of youth with and without

programmes contribute to reduced risks of suicides.

disabilities across South Africa66 found there was a large

Awareness of their rights should enable disabled youth to

difference in school attendance and/or completion between

advocate for their needs at local government level to create

non-disabled and disabled youth (99.3% v. 82.4%). There is poor

an inclusive environment in which they are able to participate

retention of disabled youth from the primary to the secondary

in

level of schooling. Key barriers in accessing education included

collaborative learning would help address the social injustices

inadequate support to equip teachers and parents with the

experienced by disabled youth.72 Empowerment of disabled

knowledge and skills to implement inclusive education; and

youth who live in impoverished contexts would create enabling

an absence of information on bursaries and other sources of

environments, inclusive attitudes, access to information and

funding. While the National Youth Policy advocates for inclusive

affordable public transport, which are some of the critical

education at all levels and accelerated implementation

factors that facilitate equal participation.73

mainstream

youth

development

opportunities.

Such

of the White Paper on Special Needs education, further

The citizenship of disabled youth can further be promoted

attention should be given to mechanisms to accelerate such

through more data describing and monitoring possible

implementation. Mechanisms should attend to the multiple

mechanisms for promoting inclusion of disabled youth. Such

interpretations of and misconceptions related to disability and

inclusive research could contribute to achieving this aspirational

inclusive education and the way that professional roles, for

goal of the National Development Plan and active citizenship by

example of therapists, are changing and influenced in response

all.

to inclusive education.67

Government has allocated increased resources to the delivery

to these policies.77 Mental health services in South Africa remain

of substance abuse treatment, expanding the number of state-

poorly resourced, with a limited focus on youth, and curatively

funded treatment slots and training additional health and social

oriented rather than focusing on preventive and promotive health.78

workers to deliver these services.

It is, however, important to

Despite the strong association between substance misuse and

ensure high quality of services a priority captured in the countrys

mental health problems, integration of drug and mental health

National Drug Master Plan75 which will require routine monitoring

treatment is lacking,79 as are initiatives to address the strong

and evaluation.

connections between youth mental health problems, poverty and

74

violence.80
Mental health
provide culturally sensitive, safe and supportive mental health

What can strengthen initiatives to improve

youth health?

environments and counselling, and improve access to mental

There is no doubt that youth health and well-being need to be

health services with a focus on community-based models of care.76

approached on multiple fronts, given the complex relationships

However, there are no implementation guidelines to give effect

between alcohol use, violence, and unsafe sexual behaviours.81

South Africas mental health policies aim to promote information,

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Youth and the intergenerational transmission of poverty

65

Programmes fostering warm and caring relationships and

sector programmes, are also needed. Mental health screening

communication between caregivers and adolescents on sexual

among youth should be prioritised, tailored for different female

and other life issues can be a major protective factor for youth

and male needs, and aligned with government plans for expanded

health.82 Initiatives that promote equitable intimate relationships,

school-based health services.89

rather than male dominance, are another key protective factor for

The National Youth Policy 2015 202090 includes a strong focus

the health of both young women and men, as positive intimate

on heath care and combating substance abuse, and recognises the

relationships during youth entrench long-term, positive sexual

need for a holistic approach. Key recommendations include:

relationships.83

strengthening the district health system to ensure more

The Integrated School Health Policy promises, if well

implemented, to provide a comprehensive, intersectoral package

equitable access to health care services and address barriers

that inhibit young peoples access to SRH services;

of health care counselling services for school-going youth. In

a holistic approach to youth with a strong focus on physical

addition, schools should create a safe social environment that

exercise and provision of recreational facilities and the

supports good physical and mental health, and provides care and

promotion of interpersonal and coping skills through the life

orientation curriculum;

support for teaching and learning.

Facility-based health services with improved youth accessibility,
staff attitudes and confidentiality are also required,84 as are initiatives
offering recreation and community-based services . Greater
85

linkages between clinics and non-governmental programmes are

needed, and innovative forms of health service delivery tailored to
youth needs should be implemented and evaluated.
Integration of health care and social support services and
stronger mechanisms for transitioning adolescents between
school and adult public health services could improve youth health
outcomes. Establishing out-of-facility health services such as those
in case 7 should be a priority.
Effective initiatives to prevent violence amongst youth that
also address risk factors at both individual and community level
are needed. For example, the Violence Prevention Through Urban
Upgrading programme in Khayelitsha, Cape Town, while its impact
remains to be assessed, has adopted an integrated approach
by: addressing the underlying causes of violence (and crime)
through socio-economic development; re-arranging the physical
environment to decrease the likelihood of violence and crime, and
providing support to victims of violence.86
Greater political action is needed to implement policies and
plans and put in place the resources needed to address genderbased violence in particular. While government established an InterMinisterial Committee on Violence Against Women and Children in
2012 and a Programme of Action87 was published in 2014, concrete
implementation of the proposed actions and monitoring and
evaluation of its impact are required to assess its effectiveness.

a similar emphasis on building self-esteem and mutual respect

to prevent violence and unsafe sex; and
stricter enforcement of municipal by-laws to restrict access to
alcohol.
Global recommendations to improve youth health similarly
highlight the importance of engaging sectors beyond health in
order to create safe schools and communities. The World Health
Organization highlights the value of collecting strategic information
on core youth health indicators to measure determinants, coverage
and the impact of policies, programmes and services.91 In addition,
the following key principles should inform the design and delivery
of youth health initiatives:
recognise the underlying social determinants of youth health
including gender, economic status and geographic location;
avoid conceptualising youth sexuality as only associated with
risk and enhance youths agency to choose healthy sexual
behaviour;
build youth capacity, involvement and leadership in integrated
youth programme development and implementation;
recognise the limitations of interventions aimed at shifting
individual health behaviour and address changes needed in
social contexts;
mobilise communities to address gender inequality and promote
youth health; and
engage with young men to encourage equitable and safe
relationships.

Improved prevention strategies are also needed to discourage

The health problems reviewed in this chapter share many common

under-age drinking. This includes challenging current drinking

underlying interpersonal, social and economic causes such as peer

norms and practices, and ensuring the buy-in and support of high

pressure, lack of positive family or community role models, poverty,

school and community leaders.

poor quality education and unemployment. This underscores the

88

Better access to drug rehabilitation services, as well as stronger

need for integrated and multi-pronged health strategies, including

linkages between alcohol and drug rehabilitation and mental health

those focusing on mental health, to promote youth health and wellbeing.92

66

South African Child Gauge 2015

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